Earlier antiretroviral initiation is independently associated with better arterial stiffness in children living with perinatally acquired HIV with sustained viral suppression in Mozambique

Background: Cardiovascular disease is a major driver of morbidity and mortality in adults living with HIV. The drivers of cardiovascular disease in children living with perinatally acquired HIV (PHIV) with sustained HIV viral suppression are unclear. Objectives: We explored the contribution of HIV-...

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Autores principales:	Igor S. Dobe, Ana O. Mocumbi, Noorjean Majid, Birhanu Ayele, Sara H. Browne, Steve Innes
Formato:	article
Lenguaje:	EN
Publicado:	AOSIS 2021
Materias:	viral suppression long-term art pulse wave velocity large arterial elasticity arteriosclerosis Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/d5bfe172a95347faa555c3d38f1390db
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spelling	oai:doaj.org-article:d5bfe172a95347faa555c3d38f1390db2021-11-24T07:47:22ZEarlier antiretroviral initiation is independently associated with better arterial stiffness in children living with perinatally acquired HIV with sustained viral suppression in Mozambique1608-96932078-675110.4102/sajhivmed.v22i1.1282https://doaj.org/article/d5bfe172a95347faa555c3d38f1390db2021-10-01T00:00:00Zhttps://sajhivmed.org.za/index.php/hivmed/article/view/1282https://doaj.org/toc/1608-9693https://doaj.org/toc/2078-6751Background: Cardiovascular disease is a major driver of morbidity and mortality in adults living with HIV. The drivers of cardiovascular disease in children living with perinatally acquired HIV (PHIV) with sustained HIV viral suppression are unclear. Objectives: We explored the contribution of HIV-specific risk factors to arterial stiffness independently of traditional risk factors (metabolic syndrome [MetS]) in prepubertal children with PHIV with sustained viral suppression in a low-income country in Africa. Method: For this cross-sectional analysis, arterial stiffness was assessed by pulse wave velocity z-score (PWVz), measured using a Vicorder device. Metabolic syndrome components were measured. We retrospectively collected the antiretroviral therapy (ART) exposures, HIV stage, CD4 count and HIV viral load. A multivariate linear regression model was constructed for MetS components, retaining age and gender as obligatory variables. We then added HIV-related metrics to assess whether these had an independent or additive effect. Results: We studied 77 virally suppressed children with PHIV without evidence of cardiovascular disease (from medical history and physical examination). In the initial model, the PWVz was independently associated with each MetS component. The PWVz was higher in participants with proportionally greater visceral fat (waist/height ratio), elevated lipids (triglyceride/high-density lipoprotein ratio) and insulin resistance (log homeostatic model assessment [HOMA]). The addition of age at ART initiation increased the model R2 value from 0.36 to 0.43. In the resulting model, younger age at ART initiation was independently associated with a better PWVz (P 0.001). Conclusion: Earlier ART initiation was independently associated with lower large artery stiffness. This effect was independent of the effect of elevated lipids, visceral fat and insulin resistance.Igor S. DobeAna O. MocumbiNoorjean MajidBirhanu AyeleSara H. BrowneSteve InnesAOSISarticleviral suppressionlong-term artpulse wave velocitylarge arterial elasticityarteriosclerosisPublic aspects of medicineRA1-1270ENSouthern African Journal of HIV Medicine, Vol 22, Iss 1, Pp e1-e6 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	viral suppression long-term art pulse wave velocity large arterial elasticity arteriosclerosis Public aspects of medicine RA1-1270
spellingShingle	viral suppression long-term art pulse wave velocity large arterial elasticity arteriosclerosis Public aspects of medicine RA1-1270 Igor S. Dobe Ana O. Mocumbi Noorjean Majid Birhanu Ayele Sara H. Browne Steve Innes Earlier antiretroviral initiation is independently associated with better arterial stiffness in children living with perinatally acquired HIV with sustained viral suppression in Mozambique
description	Background: Cardiovascular disease is a major driver of morbidity and mortality in adults living with HIV. The drivers of cardiovascular disease in children living with perinatally acquired HIV (PHIV) with sustained HIV viral suppression are unclear. Objectives: We explored the contribution of HIV-specific risk factors to arterial stiffness independently of traditional risk factors (metabolic syndrome [MetS]) in prepubertal children with PHIV with sustained viral suppression in a low-income country in Africa. Method: For this cross-sectional analysis, arterial stiffness was assessed by pulse wave velocity z-score (PWVz), measured using a Vicorder device. Metabolic syndrome components were measured. We retrospectively collected the antiretroviral therapy (ART) exposures, HIV stage, CD4 count and HIV viral load. A multivariate linear regression model was constructed for MetS components, retaining age and gender as obligatory variables. We then added HIV-related metrics to assess whether these had an independent or additive effect. Results: We studied 77 virally suppressed children with PHIV without evidence of cardiovascular disease (from medical history and physical examination). In the initial model, the PWVz was independently associated with each MetS component. The PWVz was higher in participants with proportionally greater visceral fat (waist/height ratio), elevated lipids (triglyceride/high-density lipoprotein ratio) and insulin resistance (log homeostatic model assessment [HOMA]). The addition of age at ART initiation increased the model R2 value from 0.36 to 0.43. In the resulting model, younger age at ART initiation was independently associated with a better PWVz (P 0.001). Conclusion: Earlier ART initiation was independently associated with lower large artery stiffness. This effect was independent of the effect of elevated lipids, visceral fat and insulin resistance.
format	article
author	Igor S. Dobe Ana O. Mocumbi Noorjean Majid Birhanu Ayele Sara H. Browne Steve Innes
author_facet	Igor S. Dobe Ana O. Mocumbi Noorjean Majid Birhanu Ayele Sara H. Browne Steve Innes
author_sort	Igor S. Dobe
title	Earlier antiretroviral initiation is independently associated with better arterial stiffness in children living with perinatally acquired HIV with sustained viral suppression in Mozambique
title_short	Earlier antiretroviral initiation is independently associated with better arterial stiffness in children living with perinatally acquired HIV with sustained viral suppression in Mozambique
title_full	Earlier antiretroviral initiation is independently associated with better arterial stiffness in children living with perinatally acquired HIV with sustained viral suppression in Mozambique
title_fullStr	Earlier antiretroviral initiation is independently associated with better arterial stiffness in children living with perinatally acquired HIV with sustained viral suppression in Mozambique
title_full_unstemmed	Earlier antiretroviral initiation is independently associated with better arterial stiffness in children living with perinatally acquired HIV with sustained viral suppression in Mozambique
title_sort	earlier antiretroviral initiation is independently associated with better arterial stiffness in children living with perinatally acquired hiv with sustained viral suppression in mozambique
publisher	AOSIS
publishDate	2021
url	https://doaj.org/article/d5bfe172a95347faa555c3d38f1390db
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Earlier antiretroviral initiation is independently associated with better arterial stiffness in children living with perinatally acquired HIV with sustained viral suppression in Mozambique

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